Effects of Helicobacter pylori Infection on Long-Term Risk of Peptic Ulcer Bleeding in Low-Dose Aspirin Users

Chan FK, Ching JY, Suen BY, Tse YK, Wu JC, Sung JJ

BACKGROUND & AIMS: Current guidelines recommend testing for Helicobacter pylori infection among users of low-dose aspirin (ASA) who are at high risk for developing ulcers. However, it is not clear whether this strategy affects long-term risk of ulcer bleeding. We assessed the utility of testing ASA users with high risk of ulcer bleeding for H pylori infection.

METHODS: In a prospective study, we recruited 3 cohorts of ASA (?160 mg daily) users. The first group included H pylori -positive users of ASAs with bleeding ulcers in whom the infections were eradicated (n=249). They resumed ASA after ulcer healing and H pylori eradication. The second group included H pylori -negative (past and present ) users of ASA who developed bleeding ulcers (n=118). They received enteric-coated ASA after ulcer healing. The average-risk cohort included new users of ASA without a history of ulcers (n=537). None of the subjects received regular treatment with anti-ulcer drugs. The primary endpoint was ulcer bleeding with ASA use in 5048 patient-years of follow-up

RESULTS: The incidence of ulcer bleeding (per 100 patient-years) in the Hp-eradicated cohort (0.97; 95% confidence interval [CI], 0.53-1.80) did not differ significantly from that of the average-risk cohort (0.66; 95% CI, 0.38-0.99). The Hp-negative cohort had a high incidence of recurrent bleeding (5.22; 95% CI, 3.04-8.96) (incidence rate ratio, 8.52; 95% CI, 4.29-16.95 vs the average-risk cohort).

CONCLUSIONS: The long-term incidence of recurrent ulcer bleeding with ASA use is low after H pylori infection is eradicated. ASA users without current or past H pylori infections who develop ulcer bleeding have a high risk of recurrent bleeding. Tests for H pylori infection can be used to assign high-risk ASA users to groups that require different gastroprotective strategies.